HomeMy WebLinkAboutNCC211162_NOI Application_20210301Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 2/25/2021 9:58:16 AM (NCG01 NOI Submission)
Approve by Clark, Paul 2/25/2021 12:38:42 PM (Review- Construction NOI 45393)
• Gamble, Aana C reassigned the task to Clark, Paul 2/25/2021 10:19 AM
. The task was assigned to Gamble, Aana C by round robin distribution 2/25/2021 9:59 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: March 1, 2021 5:00 PM
2/25/2021 9:59 AM
Submit by Selkane, Aziza 3/1/2021 10:26:16 AM (Payment Verification for NCC211162)
* Joshua Baird
• Selkane, Aziza assigned the task to Selkane, Aziza 3/1/2021 10:25 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: April 8, 2021 5:00 PM
2/25/2021 12:39 PM
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1
NORTH CAROLINA
EnrlronmertW quallly
A. Project Information
Part A.
Project Location and Waterbody Information
Are you submitting r No
an NOI that was r Yes
rejected before?
Previous Rejected 45005
NOI No.
Prior Reviewer Paul Clark
Name
1a. Project Name * Town of Clayton Neuse River WRF - Access Road and WRF Site Early Grading
Plan
1 b. Specific Lot
This field nay be used to list specifc lot numbers.
Numbers
N/A
1 c. Parcel ID
List all Rkh associated w ith this project.
Number(s) (PIN)
166900-79-1467
166900-68-3043
166900-78-4101
166900-76-7638
166900-88-7300
166900-96-3988
2. County*
Johnston
3. Highway or Street 1200 N O'Neil St
Address* Street narre only is acceptable if no address nunber assigned yet
4.CityorTownship* Clayton
5. State * NC
6. Zip Code * 27520
7. Latitude * Enter the latitude in decirral degrees
35.6695
8. Longitude* Enter the longitude in decir al degrees (MJSTbe negative)
-78.4416
If you do not know the latitude and longitude coordinates for this project, you can search the location on this map of
North Carolina. Look for the coordinates in the bottom left corner.
9. Date to Begin*
07/01/2021
Estimated Construction Project Start Date
10. Date to End*
01/01/2022
Estimated Construction Project End Date
11. SIC (Primary)*
Other (9999)
Standard Industrial aassification for Ceveloprrent
12. Acres to be
30.00
disturbed*
(including off -site borrow and waste areas)
13. Total site area 30.00
(acres) *
14. Post- 0.00
construction (Estimated)
impervious area
(acres) *
NCC Project NCC-JOHNS-2021-Town of Clayton Neuse River WRF - Access
Tracking ID Road and WRF Site Early Grading Plan
Assigned automatically
Below you must enter waterbody information for surface waters affected by this project. Please consult
DWR's Surface Water Classifications Map Viewer to find waterbody name and corresponding index number. Please
enter only immediate receiving waterbodies - not waters downstream of those unless the project extends there. You
may enter up to 3 waterbodies if needed.
15a. Receiving Neuse River
Waterbody* Narreof waterbody into which stormwater runoff will discharge
15b. Waterbody 27-(38.5)
Index No. * NCWaterbody Index Nurrber
Stormwater F No
discharges will flow 17 Yes
to additional
wate rs *
15c. Additional UT to Neuse River
Receiving Waterbody narre
Waterbody
15d. Waterbody N/A
Index No. NCWaterbody Index Number
15e. Additional Waterbody name
Receiving
Waterbody
15f. Waterbody NCWaterbody Index Number
Index No.
16a. Is this project r Yes
subject to the NC r No, not subject to NC SPCA
Sediment Pollution
Control Act?*
B. Permittee Information
Part B. ^
F2rnittee Inforrration - Legally Fbsponsible Entity and Individual
Important: The person who signs the NOI Certification Form and signs the Certification in Section E of this application
form should be the same person as listed in THIS SECTION, or an authorized responsible individual within the same
organization. That person must be a responsible corporate officer who owns or operates the construction activity, such
as a president, secretary, treasurer, or vice president, or a manager that is authorized in accordance with Part IV,
Section B, Item (6) of the NCG010000 General Permit. For more information on signatory requirements, see Part
IV, Section B, Item (6) of that permit.
1. Organization Legally Pesponsible Entity
Name * Town of Clayton
It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field.
Note: The organization name must match the business entity name registered with the NC Secretary of State. You can
verify the registration here.
2. First Name * Richard
If Corporation, enter Faegistered Agent First %rre
3. Last Name* Cappola
It Corporation, enter Pbegistered Agent Last %rre
3b. Title Deputy Town Manager
4. Permitee E-mail prj-NewWRF@townofclaytonnc.org
Address*
5. Permittee 919-553-5002
Telephone No.*
6. Permittee Mailing Street Address
Address* PO Box879
Address Line 2
Clayton
Fbstal / Zip Code
27528
Check box if the F Yes
street address the
same as mailing
address
State / Ffovince / Fbgion
NC
Country
United States
7. Permittee Street
Street Address
Address*
653 NC-42
Address Line 2
city
State / Frovince / Region
Clayton
NC
Fbstal / Zip Code
Country
27520-5804
US
8. Type of
Ownership is only individual if an individual is naned in B.1. above.
Ownership*
Government- Municipal
C. Site Contact Information
Part C.
Roject Site Contact Inforrration
....................................................................................................................................................................................................
1. Primary Site
Richard
Contact - First
Name *
2. Primary Site
Cappola
Contact - Last
Name *
3. Title
Deputy Town Manager
4. Site Contact E-
prj-NewWRF@townofclaytonnc.org
mail Address*
5. Site Contact
919-553-1530
Telephone No.
6. Organization
Town of Clayton
Name
7. Site Contact
Street Address
Mailing Address*
PO Box879
Address Line 2
City
Clayton
Fbstal / Zip Code
27528
8. Consultant Name
(Optional)
WithersRavenel
First and Last nacre
9. Consultant E-mail
muvicker@vathersravenel.com
This person will be copied on all correspondence.
10. Consultant
919-535-5185
Telephone No.
11. Billing E-mail
(For Annual Fee correspondence)
muvicker@withersravenel.com
Default is legally responsible person e-rrail
12. Billing
(For Annual Fee correspondence)
Telephone
919-535-5185
Default is legally responsible person telephone
State / Rovince / Region
NC
Country
United States
D. E&SC Plan
Part D. ^
Erosion & Sediment Control (E&SC) Ran Approval Information
......................................................................................................................................................................................................................................................................................................................................
1. Date E&SC Plan 02/15/2021
Approved *
2. E&SC Plan Project JOHNS-2021-020
Number/ID * Assigned by agency or local program
3. E&SC Plan r State DEQ Office
Approved by* r Local Program
4. State DEQ Office * Raleigh (RRO)
Documentation of E&SC Plan approval and the signed Notice of Intent (NOI) Certification Form is required for a
complete application. Please also upload a site map showing the overall extent of the project (for linear projects, can
include the beginning point and end point coordinates in the "Notes" box below).
5. E&SC Plan
JOHNS-2021-020_20210215_LOA.pdf 266.21KB
Approval letter or
Mist beRDFformat
Grading Permit
6. Site Location Map
Wst be RDFfornat (lint 20 [vB)
Access Road and WRF Site Early Grading Plan -
4.43MB
Aerial Map.pdf
Rease do not upload entire set of E&SC plans.
7. Notes (Optional)
Frovide any additional information that night help the reviewer better understand how uploaded documents support
the application. Include additional w aterbodies if necessary.
See the attached letter of approval and aerial map showing the
access road / water line route and grading area. Also see the
attached, updated NOI certification form with signatures.
8. NOI Certification
2020-02-17 - Access Rd eNO1- TOC Signature.pdf 92.48KB
Form
IvLst be R7Ffon-rat
This is an Express
r No
Review Project*
r Yes
E. Certification
North Carolina General Statute 143-215.66 (1) provides that:
Any person who knowingly makes anyfalse statement, representation, or certification in any application, record, report, plan, or other
document filed or required to be maintained under this Article or a rule implementing this Atide; or who knowingly makes a false statement
of a material fact in a rulemaking proceeding or contested case under this Atcle; or who falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring device or method required to be operated or maintained under this Atide or rules of the
Commission implementing this Atcle shall be guilty ofa Class 2 misdemeanor which may include a fine not to exceed ten thousand
dollars ($10,000).
Under penalty of law, I certify that:
17 I am the person responsible for the construction activities of this project, for
satisfying the requirements of this permit, and for any civil or criminal penalties
incurred due to violations of this permit.
rJ The information submitted in this NOI is, to the best of my knowledge and belief,
true, accurate, and complete based on my inquiry of the person or persons who
manage the system, or those persons directly responsible for gathering the
information.
* 17 I will abide by all conditions of the NCG010000 General Permit and the
approved Erosion and Sediment Control Plan.
* rJ I hereby request coverage under the NCG010000 General Permit and
understand that coverage under this permit will constitute the permit
requirements for the discharge(s) and is enforceable in the same manner as an
individual permit.
Specify if you are:* IT The Legally Responsible Person named on this Notice of Intent
f Authorized Responsible Person* (signing on behalf of Legally Responsible
Person named in Part B)
Important: The person who electronically signs this Certification above must be the same person who signs the NOI
Certification Form. If that person is signing on behalf of the Permittee, that individual must be an authorized responsible
person within the same organization as the Permittee. *An authorized individual is a responsible corporate officer who
owns or operates the construction activity, such as a president, secretary, treasurer, or vice president, or a manager
that is authorized in accordance with Part IV, Section B, Item (6) of the NCG010000 General Permit. For more
information on signatory requirements, see Part IV, Section B, Item (6) of that permit.
Signature
Type Name * Richard D. Cappola Jr.
Title Deputy Town Manager
Organization Legally Plesponsible Entity
Town of Clayton
Date * 02/25/2021
F. Tracking and COC Info
NOI Tracking No. 45393
NC Reference No.
NCG01-2021-1162
Uses 'count_nurrber' variable (increrrented by SP)
Certificate of
NCC211162
Coverage (COC)
Uses 'count_nurrber' variable (increrrented by SP)
No.*
Count Number 1162
Sequential nurrber for subrrittal that is incremented by Stored Frocedure
COC Year 2021
Year of date reviewed (used to assign YY digits after "NOC' in COCno.)
Initial Invoice No. NCC211162-2021
Invoice Due Date 3/27/2021
Initial Fee $ 100.00
Invoice Status OPEN